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Home Sleep Study - Low AHI but significant desat
#21
RE: Home Sleep Study - Low AHI but significant desat
Your starting off great, the right machine and attitude. Aerophagia, AKA air swallowing, I've dealt with some as a noob that has GERD. OK you're already at Max EPR 3 so maybe try slight head of mattress elevation if possible and/or bias to left side sleeping.
Dave

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Standard OSCAR Chart Order
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Dealing With A DME
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#22
RE: Home Sleep Study - Low AHI but significant desat
Second night was interesting, but in different ways.  
The increased minimum pressure made a world of difference.  I only had a couple of moments where I felt like I wasn't getting enough air, but they passed pretty quickly.  The improvement was notable.  Thanks for that advice, Gideon.

I also switched to smaller nasal pillows and my nose feels much better this morning, with fewer overall leaks through the night.

I did have quite a few clear airway events, many of which appear to be honest events and not related to me being awake.  I startled awake many times feeling like someone had turned on a firehose of air and I was drowning in it.  Not sure how that works, but it was repeated multiple times so I didn't imagine it.

As suggested, I tried to stay on my left side since I can't raise the head of my bed.  And by attempting this position, I confirmed that my pillow isn't going to work and will be looking for a new one.

But...the good (no, actually it's great!) news is that my O2 improved significantly.  I've included in the attached Oscar screenshot.  According to the Viatom software, I spent less than one minute under 90% saturation.  Compare that to more than 2 hours below 90% on many previous nights.  And, even though I tossed and turned more than I would have liked throughout the night, I feel amazing today.  I told my husband that even if it's a placebo effect, I'll take it.   Big Grin

Unless you see something that jumps out as concerning, I'm going to hold onto these settings for a bit and get more comfortable with the machine before I make any additional changes.  

Overall, I'm very happy and thankful for the advice you all offered to push the doc to write the CPAP prescription.

   
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#23
RE: Home Sleep Study - Low AHI but significant desat
No settings edits from me. Just a suggestion to watch specific OSCAR data, your flow limits graph is still a bit on the shaggy grass look.

I think earlier the CA was supposed to be breath hold and moving around ish stuff. If correct, disregard those CA clusters.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#24
RE: Home Sleep Study - Low AHI but significant desat
No problem withholding these settings as long as your comfort holds

Two things to try.
1. Another increase in min pressure, by 1. See if this further helps. Subjectively chose which is best. Your choice.
2 lower EPR, goal to reduce central Apnea. Note that thisay increase obstructive events. Looking for a balance between obstructive and central that feels comfortable for you.
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#25
RE: Home Sleep Study - Low AHI but significant desat
(04-24-2021, 02:56 PM)SarcasticDave94 Wrote: No settings edits from me. Just a suggestion to watch specific OSCAR data, your flow limits graph is still a bit on the shaggy grass look.

I think earlier the CA was supposed to be breath hold and moving around ish stuff. If correct, disregard those CA clusters.

Thanks for pointing out the grass look.  It is kind of crazy - today's chart looks similar.  I'm guessing a bump in pressure should help that?
  
The CAs the first night were definitely tied to awake time, but I was awake a lot that first night.  The past two nights I compare the data with my memories of being awakened plus the movement stats from the Wellue ring and it does appear that a portion of the CAs are real.  At least, that's what my inexperienced eyes see.  Please tell me if I'm interpreting it wrong.

(04-24-2021, 03:23 PM)Gideon Wrote: No problem withholding these settings as long as your comfort holds

Two things to try.
1. Another increase in min pressure, by 1.  See if this further helps.  Subjectively chose which is best.  Your choice.
2 lower EPR, goal to reduce central Apnea.  Note that thisay increase obstructive events.  Looking for a balance between obstructive and central that feels comfortable for you.

I didn't read this until too late to change for last night, but I do think I'll increase the pressure by one tonight - I still had a few minutes of wishing for more air flow during the night.   If that goes ok, then I'll lower the EPR, I think.  I'm not so worried about obstructive events - they weren't a problem in the sleep study and I've only see a couple show up in the Oscar reports, so I'm going to focus more on the centrals.

Thanks to both of your for your inputs.  I feel great again today. Brain fog lifted yesterday and today is similar.  The O2 staying above 90% seems to work magic.

Side note - I did wake up a couple of times with my mouth open, leaking air into the world.  If that keeps happening, I guess I need to think about a strap or taping.  But I'm hopeful that it doesn't become too big of an issue.

   
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#26
RE: Home Sleep Study - Low AHI but significant desat
If there's disruptions to sleep and you think it needs addressed, the FL are a likely culprit. And with EPR at 3, the only solution for FL with this PAP is Min pressure goes up. Your call in acting on it or not. You can try a fractional bump up or a whole step and see if comfort is OK and FL is going down.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#27
RE: Home Sleep Study - Low AHI but significant desat
I wouldn’t be tooo worried about the CA’s for now and they are fairly low with the total AHI due to CA’s slightly over 3 but one quick question as your in Colorado are you living at altitude ? As altitude can cause a higher than usual CA reading for some people.
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#28
RE: Home Sleep Study - Low AHI but significant desat
(04-25-2021, 02:58 PM)jaswilliams Wrote: I wouldn’t be tooo worried about the CA’s for now and they are fairly low with the total AHI due to CA’s slightly over 3 but one quick question as your in Colorado are you living at altitude ? As altitude can cause a higher than usual CA reading for some people.

Yep.  I live at 7300 feet, so I'm at a higher than normal altitude.  I'm pretty sure that's the complicating factor in all of this.  
As long as those CAs don't continue to cause me to desat significantly, I will happily ignore them.   Smile
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#29
RE: Home Sleep Study - Low AHI but significant desat
Of course it's probably a bit late now, but given higher altitude, a good idea is to do your diagnosic and titration sleep studies at about that same altitude as home.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#30
RE: Home Sleep Study - Low AHI but significant desat
Quick updates and a few observations.  Not asking for anyone to spend time or brainpower on assistance today since I'm really doing and feeling fine at this point.  But I did find something that I thought was worth noting, and that I'm going to pay some attention to because it looks like a trend (as much as a few days can be a trend... [Image: rolleyes.gif] ) that might explain my history of desats without having "real" apnea.

First the updates:
- I increased pressure to 9 as recommended and it felt like too much air, so I dropped back to 8.6 the following night, which then felt like not enough air.  I think I acclimated to the 9 level by the end of the first night but didn't realize it, so dropping pressure was the wrong answer.  I'm going to go back to 9 tonight and I'm expecting it to be more comfortable.  Both nights produced less positive results than the earlier nights.  (Note that less positive results are still way better than any of my "best" nights pre-CPAP, so that's not a complaint.  It's just an observation as I'm absorbing data and trying to understand.)  
- I'm swallowing less air so I think that part is just a biological learning curve.
- I'm having small leaks that appear to be an issue with my pillow knocking the mask off-kilter.  The leaks don't wake me up, so I'm investigating other pillow options but not too focused on that at the moment.

Now the observations:
- My AHI is very low and is based almost completely on the miscellaneous CAs scattered through the night.  This isn't surprising since my AHI started low and was never the issue.  The desats were the entire issue for me.
- When I was taking a curiosity-driven look at some of the CAs and desats, I realized that most of my flagged CAs are surrounded by shorter, but steadily lengthening mini-CAs.  These mini-CAs aren't long enough to flag, but are definitely working together to cause the drops in oxygen.  I've included an example here where the SpO2 dives significantly after a series of mini-CAs and one flagged CA.  I wasn't awake at the time - there is no indication of movement that would cause false CAs.  This is consistent across all of my data so far, which is why I'm calling it a "trend".
- My GP who was very supportive of writing the CPAP prescription based on my desats made a side comment during the appointment related to CAs.  She said that she usually discounts CAs because 99% of the time they represent the use of depressives (alcohol, narcotics, etc.).  But I don't use any of those so that's not the case for me.  (I take only one medicine - Synthroid - and my thyroid levels are very well controlled so I don't think that plays here.)
- So....I'm going to target those CAs and see if reducing them brings my oxygen up more consistently.  If I understand correctly, that will require me to get rid of EPR.  So I'm going to start by dropping it one level each night until I'm at zero.  Three nights from now I should be at 9-14, 0EPR, and hopefully see a reduction in those CAs (and maybe a full night of SpO2 above 90% like a normal person.)  [Image: cool.gif]


Thanks for listening to my semi-random thoughts and analysis.  Feel free to shoot holes in my theories if warranted.  As always - I'm trying to learn more about this stuff and I expect to make mistakes.

   
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